Last November, the Supreme Court heard a nightmarish case that threatened to destroy a significant portion of the United States’ social safety net. Had the defendants’ arguments in Health and Hospital Corporation v. Talevski prevailed before the justices, federal Medicaid law could have been rendered practically unenforceable — leaving patients with no resource if they were unlawfully denied care or abused by their health providers.
But the Court rejected that approach in a 7–2 decision. It’s also Justice Ketanji Brown Jackson’s first majority opinion in a case with this kind of sweeping policy stakes.
The case involved a somewhat byzantine area of federal law. Medicaid is a “conditional grant” program, meaning that the federal government offers a significant chunk of money to each state (total federal Medicaid spending in 2020 was more than $670 billion), which states are free to take or leave. Should they take the money (and all 50 states take at least some Medicaid funds), however, the states and Medicaid-funded health providers are required to comply with certain requirements laid out in federal law.
These conditions range from broad requirements that state Medicaid programs must cover certain individuals, such as low-income pregnant patients and children, to granular rules governing how Medicaid-funded facilities must operate. The Talevski plaintiffs, for example, accuse a Medicaid-funded nursing home of violating several provisions of Medicaid law that regulate how these facilities must care for patients — including a law that forbids nursing homes from using psychotropic drugs “for purposes of discipline or convenience and not required to treat the resident’s medical symptoms.”
Under well-established law, at least some of the conditions Medicaid law imposes on states and health providers may be enforced through private lawsuits. The defendants in Talevski effectively tried to neutralize all of these lawsuits, leaving patients…
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